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Louisiana
Success
Stories: LOUISIANA
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- Eunice Community
Medical Center (ECMC), Eunice achieves a 200% increase in the number
of heart failure patients receiving written discharge instructions:
Working with Louisiana Health Care Review, the Louisiana QIO, ECMC
went from 20% to 62.5% of heart failure patients receiving written
discharge instructions. Taking advantage of resources offered through
the QIO such as pre-existing protocols, and by adopting the philosophy
of promoting accountability, the unit managers became responsible for
abstracting records and tracking their own progress over time. The
team then compared the unit-level results with the data that case managers
submitted to JCAHO. This team approach of shared responsibility substantially
improved the discharge instruction rate over 6 months during 2002.
- Louisiana Health Care Review collaborated with the Optometry Association
of Louisiana to deliver retinal eye exams to underserved Medicare diabetics
in three parishes. Several community settings were evaluated for effectiveness
of delivering the exams. The most effective setting was the Dooky Chase
restaurant, owned by New Orleans chef Leah Chase, a high-profile leader
in the African American community. Buses for transportation to the
restaurant were provided by local churches. Chef Chase was also featured
in television and newspaper advertising urging Medicare diabetics to
get an eye exam. During this project, the disparity in the biennial
eye exam rates between the African American and the Caucasian population
fell from 13.4% to 10.6%, i.e., an absolute improvement of 2.8% and
a relative improvement of 20.9%.
- Maison Hospitaliere
Pain Rate Declines from 20.49% to 7.61%. Maison Hospitaliere approached
pain management from a comprehensive perspective, by using a restorative
program, social services, and treatment of associated conditions, such
as pain and anxiety. A major area of emphasis is pain assessment for
all cognitively impaired residents and any residents who are unable
to verbalize pain. In these residents, staff watch for any changes
that might signify the presence of pain and use non-sedating analgesics
to the extent possible. Inspired by their success with pain management,
the facility is now using materials supplied by LHCR for other areas
of quality improvement.
- The
Oaks Care Center Reduces Pain Rate from a high of 32 % to 7%. Working
with LHCR, staff members of The Oaks Care Center were educated
on the importance of screening and recognizing pain. Particular emphasis
for the training was given to Certified Nursing Assistants ( CNA
). Screening tools for both the cognitively intact and impaired
were put in place, and the effectiveness of each resident’s pain
management program is tracked.
- Riverview
Care Center Reduces Pain Rate from 13% to 3%. Working with LHCR,
Riverview Care Center did an in-depth education of the CNA staff
to recognize pain in residents who are cognitively impaired. The
assistant director of nursing developed the Learn to Recognize
Pain Card Game for the staff to play in order to raise awareness
and recognition of residents in pain. To play the game, one person
must demonstrate without using words one of the emotions or needs
listed in the card guidelines. Another player must attempt to guess
what the first player is attempting to convey. This game uses an
ordinary set of playing cards and is simple to implement but has
been very effective in helping Riverview reduce its pain rate.
- Claiborne
Healthcare Center Reduces Pain Rate From 9.5% to 3% and Restraint
Rate from 15% to 3%. This facility reduced its pain rate by changing
its care plan to include pain assessments for both cognitively intact
and impaired residents. CNAs were educated on how to recognize pain
in the cognitively impaired and asked to screen residents for pain
on a weekly basis. The effectiveness of the pain regime is also tracked.
They reduced the restraint rate by leadership endorsement of the
project. Leadership encouraged staff members, who were then empowered
to seek out restraint alternatives. The staff and family were educated
on the hazards of restraint use.
- Natchitoches
Parish Hospital Long Term Care Unit Reduces Pressure Ulcers by 50%
Challenged by the Louisiana QIO to employ innovative, simple interventions,
the facility initiated a “Got Water” campaign that ensures
residents are well hydrated. Each resident is given his own water
sports bottle. Pitchers of water are added to the table, and staff
members wear “Got Water” buttons to increase awareness.
The staff also educated the CNAs to turn residents on schedule, and
to recognize skin changes, and perform a daily skin check. When Natchitoches
featured its success at the Louisiana QIO’s Quality Forum,
this quickly became the most popular take-home idea.
- Chateau
D’Arbonne Reduces Pressure Ulcer Rate by 62% and Restraint
Rate by 40% This facility incorporated its quality projects into
its electronic medical record ( EMR ) system. A beta-test showed
that the EMR was a great tool to remind staff to follow the designed
care plan and increase awareness of skin status and risk. Minimal
documentation changes helped the facility to drastically improve
care and LHCR Quality Improvement Specialists seized the moment by
urging the vendor to include best practices for pressure ulcer prevention
in the next software enhancement.
- Pilgrim
Manor Guest Care Center Reduces Pressure Ulcers From 15% to 7% and
Restraints From 20.5% to 9% One of the first homes to begin work
with Louisiana Health Care Review, Inc. on quality measures, this
facility used its multi-disciplinary pressure ulcer team to teach
CNAs how to recognize skin changes and to turn residents regularly.
Its next step was to address restraints using the team approach.
The multi-disciplinary team reviews all restraints, advising alternatives,
and makes suggestions as to which restraint can be reduced or eliminated.
- Village
Health Care at the Glen Reduces Restraint Rate From 18% to 8%. Village
Health Care at the Glen now reviews all restraints from a team approach.
A restraint is only approved after all restraint alternatives are
considered, or found ineffective.
- Northshore
Living Center Reduces Restraints by 72%. This facility has embraced
fall prevention to reduce restraints. The facility utilized the Falling
Star program to alert staff of “at risk” residents and
the Fall Buster program to key in on “high risk” residents
who experienced a recent fall. In addition, Northshore used fall
prevention contests that challenged shifts to compete against each
other for the lowest fall rates. Falls are fully investigated to
identify the cause, as well as interventions likely to prevent recurrence.
As a result of staff education, staff members are very attuned to
early identification and intervention when changes in mental status
occur.
- Lafon Nursing
Facility of the Holy Family Reduces Restraints from 56.57% to 18.75%.
Lafon Nursing Facility set out to reduce physical restraints pursuing
a multi-faceted plan. Two of the simpler tasks were scrutiny of MDS
restraint coding and the education of families. The plan also made
use of resident conditioning through activity programs, physical
and occupational therapy, monthly reviews of restraint use and identification
of ways to reduce or eliminate restraints. Lafon added a weekly fall
review, with a fall-screening process that includes having occupational
therapy assess for gait disturbances. The use of low beds and mattresses
on the floor were also instituted.
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- Guest House
of Slidell Reduces Restraintsfrom 25.88% to 10%. The Guest House
of Slidell has succeeded in reducing restraints in large part by
monitoring the process for initiating restraints and by modifying
equipment in the facility. Full bed rails were changed to half rails,
alarm systems were implement. Staff was educated, and the fall prevention
program was re-vamped.
- Riverlands
Health Care Center Reduced Restraint Rate From 21.25 to 7.14. This
facility attributes its success to education of staff and families
by a restraint committee; implementation of a more aggressive fall
prevention program, by assessing all falls to identify and eliminate
modifiable risk factors; and evaluation of equipment needs and acquisition
of devices, such as chair alarms, low beds, scoop mattresses, self-releasing
seat belts, and specialized wheelchairs.
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